Care Home: Dulverton House

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What the care home does well Dulverton House provides a very comfortable and pleasant home for the people who live there; the building is well maintained with furniture and equipment that is of good quality and in keeping with the surroundings. This is a well managed home with good records and care plans. There is a good staff training programme and all members of staff are encouraged to undertake training to aid their professional development and help them meet the needs of the people living in the home. The home has recently achieved the Investors in People Award. People living in the home spoke very highly about Dulverton House and praised the manager and staff for the way in which they were cared for. What has improved since the last inspection? During the inspection conducted in June this year it was noted that there were several areas requiring improvement. Since that inspection the provider and manager have worked extremely hard to address the issues, and all of the requirements made as a result of the inspection have now been satisfactorily addressed. What the care home could do better: The manager should complete her training course so that she achieves the necessary qualifications in both care and in management. CARE HOMES FOR OLDER PEOPLE Dulverton House 9 Granville Square Scarborough North Yorkshire YO11 2QZ Lead Inspector Ray Burton Unannounced Inspection 13th October 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Dulverton House DS0000062423.V372745.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dulverton House DS0000062423.V372745.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dulverton House Address 9 Granville Square Scarborough North Yorkshire YO11 2QZ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01723 352227 F/P01723 352227 angelawebster06@yahoo.co.uk Dr Khalid Hussain Javed Dr Mussarat Javed Manager post vacant Care Home 22 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (22) of places Dulverton House DS0000062423.V372745.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users up to 22 (OP) and up to 5 (DE(E)) up to a maximum of 22 service users 27th June 2008 Date of last inspection Brief Description of the Service: Dulverton House is a large detached building situated in a residential area of the town. A former dwelling house and hotel, it has been adapted to provide accommodation for a maximum of 22 residents. Its location makes it convenient for access to local facilities and amenities and to the town centre by public transport. Resident’s accommodation is situated across 4 floors all served by a passenger lift. The lower ground area is used solely by staff and is where the office, kitchen, laundry and staff areas are situated. Communal rooms are located on the ground floor together with some resident’s private accommodation. The rest of the bedrooms are located on the upper floors. Some bedrooms have an en-suite facility and there are ample communal bathrooms and toilets on each level. The home’s well-maintained garden, which has level access from the dining room and front of the house, provides sunny and shaded areas and appropriate seating for residents and visitors. Dulverton House is registered for 22 people over 65 year up to 5 of who may have a dementia type condition. Current fees are £341.00 to £372.00 a week. Additional charges are made for hairdressing, chiropody, toiletries, papers and magazines. Information about the services provided are made available in the home’s Statement of Purpose, Service Users Guide and through published inspection reports available from the home Dulverton House DS0000062423.V372745.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this home is 2 star. This means the people who use this service experience good quality outcomes. This inspection covered all of the key standards of the National Minimum Standards for Older People. It was conducted on 13th October 2008. The lead inspector was accompanied for part of the inspection by a pharmacy inspector from the Commission for Social Care Inspection. During the inspection the inspector looked around the home, examined various records and spoke to people living there as well as to the proprietors, manager and members of staff. The pharmacy inspector conducted a detailed audit of the medication systems. What the service does well: What has improved since the last inspection? During the inspection conducted in June this year it was noted that there were several areas requiring improvement. Since that inspection the provider and manager have worked extremely hard to address the issues, and all of the requirements made as a result of the inspection have now been satisfactorily addressed. Dulverton House DS0000062423.V372745.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Dulverton House DS0000062423.V372745.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dulverton House DS0000062423.V372745.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 5 People who use this service experience good quality outcomes in this area. Prospective residents are given information prior to admission to enable them to make an informed decision about the suitability of the home and its ability to meet their needs. The homes assessment procedure ensures no one will be admitted unless his/her needs can be met. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: The homes statement of purpose and service users guide informs prospective residents and their families about facilities available at Dulverton House. Conversation with the manager and examination of care plans showed a thorough pre-admission assessment is conducted by staff from the home; the prospective resident and, where appropriate, next of kin and healthcare professionals are involved in the assessment process. A care manager’s Dulverton House DS0000062423.V372745.R01.S.doc Version 5.2 Page 9 assessment is obtained when a referral has been made by a social services department. Prior to admission, prospective residents and their families are invited to make one or more visits to look around the home, have a meal and meet members of staff and the people already living there. One person currently considering becoming resident in the home has spent several overnight stays and has returned to her own home while she makes up her mind about entering the home on a permanent basis. If a prospective resident is unable to visit Dulverton House the manager or another member of staff will visit the person in his/ her own home or in hospital so that assessments can be carried out to determine if the home can meet the persons needs. Following admission there is a trial period during which time a person is able to decide if they wish to remain in the home. The home does not offer intermediate care; therefore standard 6 does not apply. Dulverton House DS0000062423.V372745.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 People who use this service experience good quality outcomes in this area. There has been an overall improvement in the homes care planning processes. Care plans now contain assessments identifying need and strategies to meet need. Significant improvements have been made in the handling of people’s medication. There are now good systems in place to make sure medication is accurately administered, recorded and stored. This means that people are receiving their medication safely and as prescribed. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: Examination of care plans revealed that since the inspection conducted in June this year, there has been an improvement in the standard of care planning at the home. Dulverton House DS0000062423.V372745.R01.S.doc Version 5.2 Page 11 Monitoring of health is undertaken and healthcare needs addressed by community-based professionals e.g. G.P’s, District Nursing Service, and Chiropodists etc. The manager and members of staff are able to demonstrate a sound knowledge of each resident and his/her needs. Care plans are wellorganised and contain information about the general health of the person and details of any specific condition or ailment. Risk assessments and risk management strategies have been developed in areas such as: mobility, risk of falls etc. Regular monitoring ensures changing needs are identified and appropriate action taken. Care planning documentation is now dated and signed by the member of staff responsible for formulating the plan and by the resident to signify his/her involvement and agreement to the plan. The inspector spoke to ten people living in the home, both individually and in groups; all expressed satisfaction with the way in which care and support is given and feel they are always treated with respect by staff and that their dignity and privacy is respected, particularly when being assisted with personal care needs. Policies and procedures are in place dealing with the care of residents during their final days; members of staff have received training in palliative care and spoke with sensitivity about the needs of people during the final stages of their lives. A`CSCI pharmacist inspector once again visited the home and carried out an inspection of the medication systems. The current and previous month’s Medication Administration Records (MAR) were looked at. There are now dividers between the MAR charts. Having dividers between MAR charts helps to reduce the risk of the medication being given to the wrong person. The quantity of medication supplied and the date received is recorded. The quantity of medication from one monthly cycle to another is now recorded on the new MAR. This means there is an accurate record of the amount of medication within the home, which helps when checking if medication has been administered correctly. The standard of handwritten entries and changes to medication is good. This means that there is clear and detailed information on the MAR for staff to administer from. The standard of record keeping is good; there were very few gaps on the MARs. This helps to demonstrate that people are getting their medication as prescribed. When medication prescribed with a “when required” dose such as paracetamol is administered a record is made of the reason it was given. This is good Dulverton House DS0000062423.V372745.R01.S.doc Version 5.2 Page 12 practice as it provides information for staff to monitor how often the person needs this medication and if a review of the dose is required. There is now a controlled drugs cabinet in place to securely store the medicines. The person in charge of ordering monthly medication now has sight of the prescriptions before a supply is made. This provides an opportunity to check if any new medicines or dose changes are included. Any problems with prescriptions can be addressed at this point rather than after the supply has been delivered. Dulverton House DS0000062423.V372745.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. People who use this service experience good quality outcomes in this area. The routines of daily living and activities made available are flexible and varied to suit individual expectations and preferences. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: There is a relaxed, informal and friendly atmosphere in the home. Routines are flexible and allow the people living at Dulverton House to exercise personal choice and maintain control over their lives. People living in the home are encouraged and supported to lead meaningful and stimulating lives and are offered a wide range of social activities, both inhouse and in the community. Regular activities include: quoits, indoor bowls, dominoes, quizzes, arts & crafts etc., special events such as visits by local musicians and entertainers and trips to places of local interest are also organised. Dulverton House DS0000062423.V372745.R01.S.doc Version 5.2 Page 14 Local clergy visit the home so that residents can take part in an act of religious worship if they wish. Meals are served in the dining room at set times, however there is a great deal of flexibility to allow for individual wishes and circumstances and meals can be taken in the privacy of a person’s own room. Menus show a healthy, balanced and varied diet is provided. Meals are attractively presented and alternatives are available should anyone not wish to have the dish of the day. Residents praised the standard of the food and said there is always plenty of variety. One resident said: “The quality and quantity of the food is very, very good – it is excellent. There is always plenty of choice and the sweets are marvellous and the cakes wonderful.” People living in the home said they were happy living at Dulverton House and commented about the comfortable and homely atmosphere and made many very positive comments about the staff who, they said, were always cheerful, helpful and attended to their needs in the way that they wished. Dulverton House DS0000062423.V372745.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People who use this service experience good quality outcomes in this area. The home has appropriate policies and procedures in place in relation to the protection of vulnerable adults and for dealing with complaints. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: Policies and procedures are in place to ensure the safety and protection of the people living in the home and to respond to any suspicion or allegation of abuse. Most members of staff had received training in adult protection; further training has been planned for the remaining members of staff. The home has a suitable complaints procedure stating how complaints can be made, who will deal with them, the timescale for the process and what to do if not satisfied with the way in which the matter has been handled. There have been no complaints received since the last inspection. Residents meetings are held every two months affording opportunity for people living in the home to openly discuss any problems, requests, suggestions or concerns. People living in the home said they are happy with their life at Dulverton House but said should they be concerned about any aspect of their care they would know how to make a complaint. They said they had confidence that any concern would be dealt with swiftly and appropriately by the manager or by Dulverton House DS0000062423.V372745.R01.S.doc Version 5.2 Page 16 the providers who visit regularly and play an active role in the running of the home. Dulverton House DS0000062423.V372745.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 People who use this service experience good quality outcomes in this area. The environmental standard is good, providing people with an attractive, comfortable, homely and safe place in which to live. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: The internal and external fabric of the building is maintained in good condition and the home is clean, hygienic and free from offensive odours. Dulverton House has recently been refurbished to a high standard and provides a very pleasant and homely environment for the people who live there. Improvements include: redecorating and refurnishing of communal rooms; new carpets in many parts of the building; ongoing redecorating of bedrooms; new bathroom fittings, including specialist disability equipment; new fire doors Dulverton House DS0000062423.V372745.R01.S.doc Version 5.2 Page 18 fitted to each bedroom; upgrading of kitchen. Bedrooms are all tastefully decorated and comfortably furnished, many enjoy pleasant views across Granville Square; Some of the rooms have en-suite toilet facilities, all have been fitted with a wash hand basin. Each room has been individualised by the inclusion of small items of furniture and other effects such as pictures, photographs, ornaments etc brought from the occupant’s own home. The home has a very pleasant and well maintained garden that is easily accessible from the house via French windows; seating areas have been provided and the area provides a comfortable and congenial outside space for the enjoyment of the people living there. Dulverton House DS0000062423.V372745.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People who use this service experience good quality outcomes in this area. Staff are employed in sufficient numbers, and with suitable skills and training to meet the needs of the people living in the home. We have made this judgement using a range of evidence, including a visit to the home. EVIDENCE: On the day of the inspection staff were employed in sufficient numbers to meet the assessed needs of the people living in the home. Staffing rosters showed appropriate staffing levels were maintained at all times. Since the last inspection there have been two appointments to the staff team; the personnel files belonging to those newly appointed members of staff were examined - each provided evidence that the home has a rigorous recruitment policy and procedure ensuring all necessary checks, including Criminal Records Bureau (CRB), are carried out and two satisfactory references obtained prior to commencement of employment. Personnel files and conversations with members of staff confirm all newly appointed members of staff receive induction training that meets the common induction standards. All staff complete mandatory training and are encouraged to undertake further training to aid their professional development and help Dulverton House DS0000062423.V372745.R01.S.doc Version 5.2 Page 20 them meet the needs of the people living in the home - recently completed training includes: dementia awareness and safe handling of medicines. There are fourteen permanent members of staff, nine are qualified to a minimum of NVQ level 2 in care and two are working toward achieving the award; a further four have registered for the NVQ level 3. Dulverton House DS0000062423.V372745.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 35, 36, 37, 38 People who use this service experience good quality outcomes in this area. A well managed home with a competent staff team. The health, safety and welfare of the people living in the home is protected by the homes record keeping and policies and procedures. We have made this judgement using a range of evidence, including a visit to the home. EVIDENCE: The home has policies and procedures complying with current legislation and recognised professional standards and covering all aspects of the management of the home. Records are kept to safeguard residents’ rights and to ensure the safe and effective running of the home; these are well maintained, up-to-date and stored appropriately. Members of staff are aware of their responsibilities Dulverton House DS0000062423.V372745.R01.S.doc Version 5.2 Page 22 under health and safety legislation. Regular checks of the building and equipment are undertaken and maintenance and servicing undertaken to ensure a safe and comfortable environment. People living in the home are encouraged to look after their own money and valuables; however some monies are held by the home for safekeeping. Appropriate records are kept of all financial transactions. There are various systems in place, both formal and informal to measure the homes success in meeting its aims, objectives and statement of purpose: e.g. regular care plan reviews and daily contact with residents and their relatives. The provider has recently implemented a quality assurance system to monitor and measure the quality of the service. The manager has appropriate experience and is currently undertaking a course of study that will lead to her having the required qualifications. She has recently applied to the Commission for Social Care Inspection to be registered as manager. Members of staff and residents consider the home to be well managed and express confidence in the manager who, they say, is approachable and supportive. There is a staff supervision programme in place ensuring each member of staff receives at least six formal supervision sessions a year. The home has recently achieved the Investors in People Award. Dulverton House DS0000062423.V372745.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 3 3 Dulverton House DS0000062423.V372745.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP31 Regulation 9(b)(i) Requirement The manager must achieve suitable qualifications in both management and in care Timescale for action 31/03/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Dulverton House DS0000062423.V372745.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Dulverton House DS0000062423.V372745.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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